Provider Demographics
NPI:1700214277
Name:JEMAL, RICHARD
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:JEMAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 HIGHWAY 35
Mailing Address - Street 2:STE 3
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748-1865
Mailing Address - Country:US
Mailing Address - Phone:732-284-4884
Mailing Address - Fax:732-284-4849
Practice Address - Street 1:1650 HIGHWAY 35
Practice Address - Street 2:STE 3
Practice Address - City:MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748-1865
Practice Address - Country:US
Practice Address - Phone:732-284-4884
Practice Address - Fax:732-284-4849
Is Sole Proprietor?:No
Enumeration Date:2013-10-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MG00118900237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist